The use of ventilatory management protocols for the ventilation of acutely ill patients in the intensive care unit has been continually evolving and improving. One of the most important recent areas of research and clinical interest concerns the strategy of lung recruitment, or the open lung concept (OLC). In this paper we review the pathophysiologic basis and clinical role of lung recruitment maneuvers and present our extensive clinical experience with the technique. Two modes of ventilation that prevent ventilation-induced lung injury are described: pressure-controlled ventilation and the OLC.